Integrating Community Health Workers Into the Care of Children With Type 1 Diabetes

Diabetic ketoacidosis accounts for 65% of hospitalizations in pediatric patients with type 1
diabetes, and has a mortality rate between 0.15-0.31%. Children with established type 1
diabetes have an 8% annualized risk of developing diabetic ketoacidosis, and this risk
increases during adolescence. In addition, socioeconomic and racial disparities are
associated with increased risks of poor glycemic control, hospitalization with diabetic
ketoacidosis, and even severe hypoglycemia. All of these complications are associated with
preventable harm, and lead to increased utilization of medical resources, both in the short-
and long-term. Social determinants of health account for over 75% of health outcomes. Thus,
it is not surprising that a disproportionate number of children with poor diabetes control
and recurrent hospitalization in diabetic ketoacidosis come from vulnerable underserved
populations.

In this study, Investigators will study the effect of integrating a community-based
healthcare worker into the healthcare team of children with poorly controlled type 1
diabetes. Community Health Workers (CHW) are highly motivated, community members who do not
necessarily have prior medical training, but rather they link with the healthcare team to
identify and provide relevant social supports to the family. They receive specific training
that focuses on issues relevant to improving health outcomes and adherence, by improving
medication access, reducing food insecurity, and improving health literacy. The CHW are able
to provide real-time assistance with navigating the healthcare and social services systems,
reducing family stress and breaking down community barriers to positive health behavior. The
CHW work with the family to develop goals and develop an individualized plan to reach these
goals. The role of the CHW can include home visits, phone contacts, meeting with school
representatives and accompanying patients to appointments.

At the diabetes center at The Children's Hospital of Philadelphia (CHOP), the Community
Health Worker will be assigned for one year to patients with high healthcare utilization and
/ or poorly controlled type 1 diabetes. The support provided for this year will be tailored
to the patient's needs but may include problem solving surrounding issues related to
work/education, accessing healthcare/medications, engagement with the healthcare team,
transportation, housing or food insecurity. Interactions with patients will be through home
visits, telephone encounters, text messaging or email. This will be added to their medical
care and will be documented in the patient's medical record.

Inclusion Criteria:

- A clinical diagnosis of type 1 diabetes for > 1 year

- Home address is in Philadelphia

- Either:

Over the previous one year, the sum of the following should be > 2: diabetes-related
hospitalizations plus emergency department visits plus missed appointments (on separate
days) or Hemoglobin A1c ≥ 9.5 at the time of enrollment.

Exclusion Criteria:

- Children in custody of the State where there is no identified caretaker who can
complete study procedures